Erosive pustular dermatosis of the scalp: Clinical, trichoscopic, and histopathologic features of 20 cases

Abstract

Background: Erosive pustular dermatosis of the scalp is a chronic eruption that leads to scarring alopecia.

Objective: The clinical, dermoscopic, and histopathological features and the course of the disease in 20 patients were reviewed and compared with the reports in the literature.

Methods: Gender, age at diagnosis, age at onset, duration, topography, predisposing factors, concomitant diseases, trichoscopy, histology, treatment, and outcome were taken into consideration.

Results: The mean age was 59.4 years. Androgenetic alopecia was present in 12 patients, 6 of whom showed actinic damage. Trauma was reported in 9 patients. Four patients were affected by autoimmune disorders. The vertex was the most common location. In all 20 patients trichoscopy showed an absence of follicular ostia with skin atrophy. Histopathology revealed 3 different features, depending on the disease duration. A reduction of inflammatory signs was observed in 14 patients treated with topical steroids and in all 3 patients treated with topical tacrolimus 0.1%.

Limitations: The rarity of this disease is a limitation.

Conclusions: The relatively high number of patients allowed us to identify a better diagnostic approach, using trichoscopy, and a more effective therapeutic strategy, with high-potency steroids or tacrolimus, which should be considered as first-line treatment.

Keywords: cicatricial alopecia; erosive pustular dermatosis; histology; scalp; trauma; trichoscopy.